Effect of high dose vitamin D3 therapy on serum vitamin D3 levels in vitamin D insufficient adults with cystic fibrosis
Clinical Nutrition ESPEN, Volume 23, February 2018, Pages 84-88, https://doi.org/10.1016/j.clnesp.2017.12.001
- High dose oral cholecalciferol repletion in Vitamin D insufficient adults with CF.
- Dosing of 10,000 IU from Monday to Friday for a total of 50,000 IU D3 weekly.
- Significant increase in serum 25-OHD levels post supplementation.
- Supplementation protocol needs to be tested in other CF adult cohorts.
- COPD Overview
- Reasons for low response to vitamin D take with evening meal helps ~40%
- Overview Vitamin D Dose-Response
50,000 IU weekly gets healthy people to about 40 ng
- Respond to daily Vitamin D in 2-12 months
12 week trials, like the one on this page, are often too short
Poor digestion (diabetes, Cystic Fibrosis, etc.) results in less vitamin D getting into the body
"Cystic fibrosis often affects the pancreas and digestive system because the mucus in these areas becomes thick and sticky. If this occurs, the mucus blocks normal digestive function as well as harbors infection."
Other sources of vitamin D helps a lot for people with poor digestion
- Many of the diseases which require 3 X larger doses of vitamin D to treat as to prevent are those which the digestion becomes worse: such as Cystic Fibrosis, Diabetes, Multiple Sclerosis. Parkinson's
Other forms include: Gut-friendly, Sublingual, injection, inhaled?, topical, UV, sunshine
Getting Vitamin D into your body has the following chart
And the following
Bio-D-Mulsion Forte – especially made for those with poorly functioning guts, or perhaps lacking gallbladder
Sublingual – goes directly into bloodstream
Oil: 1 drop typically contains 400 IU, 1,000 IU, or 4,000 IU, typically not taste good
Topical – goes directly into bloodstream. Put oil on your skin, Use Aloe vera cream with Vitamin D, or make your own
Vaginal – goes directly into bloodstream. Prescription only?
Bio-Tech might be useful – it is also water soluble
Vitamin D sprayed inside cheeks 2X more response (poor gut) – RCT Oct 2015
and, those people with malabsorption problems had a larger response to spray
Inject Vitamin D quarterly into muscle, into vein, or perhaps into body cavity if quickly needed
Nanoparticles could be used to increase vitamin D getting to the gut – Oct 2015
Poor guts need different forms of vitamin D has the following
Guesses of Vitamin D response if poor gut
|10||Injection: Vitamin D,|
or Calcidiol or Calcitriol
|D - Slow|
(skin patch/cream, vagina)
|6||Water soluble (Bio-Tech)||Normal||Normal|
perhaps activates VDR
(some goes into gut)
|3||Coconut oil based||Slow||Normal|
|2||Food (salmon etc.)||Slow||Normal|
|2||Olive oil based (majority)||Slow||Normal|
10= best bioavailable, 0 = worst, guesses have a range of +-2
Speed: Fast ~2-6 hours, Slow ~10-30 hours
Duration: Long ~3-6 months, Normal = ~2 months
The effect of a high dose oral cholecalciferol repletion strategy in Vitamin D insufficient adults with CF is still unknown. Therefore, we assessed the effectiveness of our current approach, giving oral vitamin D3 supplementation at a dose of 10,000 IU from Monday to Friday for a total of 50,000 IU D3 weekly in vitamin D insufficient adult with CF.
We performed a retrospective chart review of all 59 adult CF patients between the ages of 17 and 64 years routinely followed at the CF Adult Program of Winnipeg Health Sciences Centre. Through consultation with the endocrinologist, our clinic vitamin D repletion protocol for treating CF adult patients who have serum 25-hydroxyvitamin D (25-OHD) < 30 ng/ml (<75 nmol/L) was to prescribe vitamin D3 10,000 IU orally from Monday to Friday (or the weekly equivalent of 50,000 IU) for 12 weeks in addition to their regular CF vitamin that supplied from 800 to 2000 IU vitamin D3 daily. Cholecalciferol was conveniently administered orally as either one capsule (oil-based) 10,000 IU or one tablet (powder-based) 10,000 IU. All patients were instructed to obtain follow-up serum 25-OHD levels post completion of treatment.
Of the 59 adult patients at our CF Clinic, 35 patients (59%) had below optimal serum 25-OHD levels. Of the 35 patients identified, 10 patients with insufficient serum 25-OHD levels between 10 and 30 ng/ml (25–75 nmol/L) fulfilled the inclusion criteria. A significant increase in serum 25-OHD levels was observed (P < 0.01) from mean value of 21.6 ± 5.9 ng/ml (54.1 ± 14.8 nmol/L) at baseline to 31.7 ± 9.1 ng/ml (79.3 ± 22.8 nmol/L) ≥ 2 months post intervention. The current treatment approach was successful in treating Vitamin D insufficiency in 70% of the patients with low 25-OHD levels.
The results of this study demonstrate that a large number of adults attending Winnipeg Health Sciences Centre CF Clinic have serum 25-OHD levels below 30 ng/ml (75 nmol/L). This supports the need for dedicated and individualized approach to manage this condition. High dose therapy of vitamin D3, although a more aggressive treatment approach, may result in achieving optimal levels of serum 25-OHD in adults with CF.
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